Salvatore Pignatelli

Plasma chitotriosidase activity in acute Plasmodium falciparum malaria.

BACKGROUND Chitotriosidase is a functional chitinase secreted by activated macrophages. It is encoded by a gene located on chromosome 1q31-32, whose mutations may be responsible for chitotriosidase deficiency, encountered in almost 6% of Caucasian population. OBJECTIVE This study reports firstly plasma chitotriosidase activity in African children with acute Plasmodium falciparum malaria. The chitotriosidase activity was correlated to objective parameters reflecting the status of the disease and compared with those found in healthy African children. RESULTS We found that plasma chitotriosidase levels are significantly increased in African children with acute malaria (185.0+/-141.0 nmol/h/ml; median 150; range 11-521) with respect to reference values obtained in age matched African children (84.4.5+/-72.8 nmol/ml/h; median 63; range 4-350) (P<0.001). Moreover the levels of chitotriosidase were higher in African children than in Caucasian children matched for age (28.86+/-18.7 nmol/h/ml; median 24; range 1-98) (P<0.0001). A remarkable significant correlation was found between plasma chitotriosidase and reticulo-endothelial activation, as judged by thrombocytopenia degree and serum ferritin level in children with acute malaria. CONCLUSION Based on this study, it appears that genetic and environmental features might be responsible for diversity of plasma chitotriosidase activity in black children living in Burkina Faso.

Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola

BackgroundMalnutrition constitutes a public health problem throughout the world and particularly in developing countries.AimsThe objective of the study is to assess the impact of an elementary integrator composed of Spiruline (Spirulina platensis) and Misola (millet, soja, peanut) produced at the Centre Medical St Camille (CMSC) of Ouagadougou, Burkina Faso, on the nutritional status of undernourished children.Materials and methods550 undernourished children of less than 5 years old were enrolled in this study, 455 showed severe marasma, 57 marasma of medium severity and 38 kwashiorkor plus marasma. We divided the children randomly into four groups: 170 were given Misola (731 ± 7 kcal/day), 170 were given Spiruline plus traditional meals (748 ± 6 kcal/day), 170 were given Spiruline plus Misola (767 ± 5 kcal/day). Forty children received only traditional meals (722 ± 8 kcal/day) and functioned as the control group. The duration of this study was eight weeks.Results and DiscussionAnthropometrics and haematological parameters allowed us to appreciate both the nutritional and biological evolution of these children. The rehabilitation with Spiruline plus Misola (this association gave an energy intake of 767 ± 5 kcal/day with a protein assumption of 33.3 ± 1.2 g a day), both greater than Misola or Spiruline alone, seems to correct weight loss more quickly.ConclusionOur results indicate that Misola, Spiruline plus traditional meals or Spiruline plus Misola are all a good food supplement for undernourished children, but the rehabilitation by Spiruline plus Misola seems synergically favour the nutrition rehabilitation better than the simple addition of protein and energy intake.

Nutrition Rehabilitation of HIV-Infected and HIV-Negative Undernourished Children Utilizing Spirulina

The objective of this study was to assess the impact of an alimentary integrator composed of spirulina (Spirulina platensis; SP), produced at the Centre Médical St Camille of Ouagadougou, Burkina Faso, on the nutritional status of undernourished HIV-infected and HIV-negative children. We compared two groups of children: 84 were HIV-infected and 86 were HIV-negative. The duration of the study was 8 weeks. Anthropometric and haematological parameters allowed us to appreciate both the nutritional and biological effect of SP supplement to traditional meals. Rehabilitation with SP shows on average a weight gain of 15 and 25 g/day in HIV-infected and HIV-negative children, respectively. The level of anaemia decreased during the study in all children, but recuperation was less efficient among HIV-infected children. In fact 81.8% of HIV-negative undernourished children recuperated as opposed to 63.6% of HIV-infected children (Z: 1.70 (95% CI –0.366, –0.002, p = 0.088)). Our results confirm that SP is a good food supplement for undernourished children. In particular, rehabilitation with SP also seems to correct anaemia and weight loss in HIV-infected children, and even more quickly in HIV-negative undernourished children.

Factors predicting uptake of voluntary counselling and testing in a real-life setting in a mother-and-child center in Ouagadougou, Burkina Faso

Objective  To identify factors predicting uptake of voluntary HIV counselling and testing in pregnant women.

Increased levels of interleukin-12 in Plasmodium falciparum malaria: correlation with the severity of disease

Interleukin (IL)‐12, produced by mononuclear phagocytes, activates the T‐helper 1 (Th1) cells and helps, as a mediator, the innate immune response to intracellular microbes. In Plasmodium falciparum infection, this proinflammatory cytokine has immunoregulatory functions with effects on the immune response to the blood stage of disease, but also induces protection and reduces malarial anaemia. In this study, the levels of IL‐12 were determined in 73 African children, aged 2–144 months (median 19·5 months), who had severe or mild P. falciparum malaria. IL‐12 was determined using the enzyme‐linked immunosorbent assay. The levels of IL‐12 were found to be significantly elevated (21·6 ± 18·3 pg/ml) in patients who suffered less severely from the disease. In contrast, the levels of IL‐12 were found to be lower (13·1 ± 7·11 pg/ml) in patients who suffered more severely from the disease.

Epidemiology of bacterial resistance in gastro-intestinal pathogens in a tropical area

During 1999-2000 a total of 4131 faecal specimens were collected and analysed at the medical centre St. Camille at Ouagadougou. Eight hundred and twenty-six (8.0%) grew significant bacteria. Escherichia coli (35%), Salmonella spp. (15%) and Shigella spp. (10%) were most frequently isolated. A large number of E. coli strains were resistant to aminopenicillins (>90%) and cotrimoxazole (80%); for Yersinia spp the resistance was 80 and 25%, respectively. Norfloxacin was the most active antibiotic but was rarely used. The study showed that it is necessary to create antibiotic-resistance surveillance centres in developing countries so that therapy may be appropriate and the spread of antibiotic resistance to other developed countries via increased emigration may be reduced.

Plasma levels of interleukin-18 and interleukin-12 in Plasmodium falciparum malaria

Interleukin (IL)‐18 produced primarily by mononuclear phagocytes synergizes with IL‐12 for interferon‐γ production from T, B and natural killer cells. It has been also demonstrated that, in Plasmodium falciparum malaria, IL‐18 could have an immunoregulatory function. The aim of this study was to detect the plasma levels of IL‐12 and IL‐18, using an enzyme‐linked immunosorbent assay, in 105 African children affected by mild and severe Plasmodium falciparum malaria to correlate the production of these cytokines with the severity of the disease. The levels of IL‐18 and IL‐12 were higher (25·7 ± 7·6 pg/ml and 17·1 ± 7·8 pg/ml, respectively) in children with mild malaria than in children with a severe form of the disease (21·5 ± 10 pg/ml and 13·2 ± 5·5 pg/ml, respectively). A positive correlation was observed between IL‐18 and IL‐12. This finding suggests that the production of these two cytokines (IL‐18 and IL 12) may be coregulated and both have an immunoregulatory effect on the immune response in Plasmodium falciparum infection.

Towards the complete eradication of mother-to-child HIV/HBV coinfection at Saint Camille Medical Centre in Burkina Faso, Africa

The coinfection of HIV and hepatitis B virus (HBV) and their vertical transmission constitute a public health problem in sub-Saharan countries of Africa. The objectives of this research are: i) identify the pregnant women that are coinfected by HIV and HBV at Saint Camille Medical Centre; ii) use three antiretroviral drugs (zidovudine, nevirapine and lamivudine) to interrupt the vertical transmission of HIV and HBV from infected mothers; and iii) use the PCR technique to diagnose children who are vertically infected by these viruses in order to offer them an early medical assistance. At Saint Camille Medical Centre, 115 pregnant women, aged from 19 to 41 years, were diagnosed as HIV-positive and, among them, 14 coinfected with HBV. They had at least 32 weeks of amenorrhoea and all of them received the HAART, which contained lamivudine. Two to six months after childbirth, the babies underwent PCR diagnosis for HIV and HBV. The results revealed that, among these mothers, 64.4% were housewives, 36.5% were illiterates, and only 1.7% had a university degree. The rate of vertical transmission of HIV and HBV was 0.0% (0/115) and 21.4% (3/14), respectively. The 3 mothers who transmitted the HBV to their children had all HBsAg, HbeAg, and HBV DNA positive. An antiretroviral therapy that in addition to zidovudine and nevirapine includes lamivudine could, as in the present study, block or reduce the vertical transmission in HIV positive pregnant women who are coinfected with HBV.

HCV prevalence and co‐infection with HIV among pregnant women in Saint Camille Medical Centre, Ouagadougou

Objective  To determine hepatitis C virus (HCV) prevalence and the rate of HCV/human immunodeficiency virus (HIV) co‐infection in pregnant women attending Saint Camille medical centre (SCMC) in Ouagadougou.

MODIFICATION IN THE FREQUENCY OF Hb C AND Hb S IN BURKINA FASO: AN INFLUENCE OF MIGRATORY FLUXES AND IMPROVEMENT OF PATIENT HEALTH CARE

The incidence of hemoglobinopathies (Hb C and Hb S) is relatively high in West Africa. In order to calculate the gene frequency of these hemoglobinopathies, 6619 students from 23 local schools in Ouagadougou, Burkina Faso, West Africa, and 2582 individuals living in five villages near Ouagadougou, all situated in Savanna, were studied. As expected, the gene frequency in the city schools was 0.111 for the βC gene and 0.051 for the βS gene; in the five villages it was 0.122 for the βC gene and 0.047 for the βS gene. This data is somewhat different from that published in a previous study by Labie et al.2 in the humid Savanna region, that showed a higher prevalence of βC (0.14) than βS (0.03), and is in contrast to data from the arid Sahel region that showed a higher prevalence of βS (0.1) compared to βC (0.05). The higher rate of βS and lower rate of βC in students in Ouagadougou, and in the individuals living in the five villages near Ouagadougou, suggest the possible influence of migratory fluxes of the βS gene from the country region of Sahel. The dramatic increase in the prevalence of Hb SS patients, not reported in the study of Labie et al.,2 may be the result of reduced mortality due to environmental change. In addition, the improved health conditions of Hb SC and the increased life expectancy of Hb SS, may also have facilitated the increase of the βS gene and the focus on secondary prevention for the control of correlated diseases.